2020 GCR Registration
Check Here if sending Check Please send all checks to Greenbrier Christian Retreat 1234 Victory Valley Rd. Crawley, WV 24931
Check this box if you are registering only WITHOUT payment. I understand that my registration is not guaranteed until registration fee has been paid.
REGISTER only without payment
Name on Card
Credit Card Type
Credit Card Number
3 Digit Security Code
Expiration Date (mm/yy)
Amount I am authorizing GCR to debit from my credit card listed above. IF $0 then enter 0 for total
By signing I authorize GCR to debit from credit card above for the amount entered above. I understand that this is a one time transaction. I also understand that any registration fees will be non refundable. Camp fees will be non refundable if no cancelation notice is sent 24 hours before event.
Participant Full Name
Relationship to Participants:
ADULT Camper or Attendee CHECK THIS and Skip this section
First Name (Parent/Guarantee)
Parent or Guardian Picture of Valid Non Expired Drivers License
Please list all medical needs and allergies:
Name of Doctor:
Doctor Phone Number:
Date of last Tetanus Shot
List all medications with distribution instructions:
Who to contact in case of emergency
CONSENT AND RELEASE FORM FOR CAMPERS AT GREENBRIER CHRISTIAN RETREAT
I, the undersigned parent or guardian, hereby consent to my child listed on this form, participating in the activities connected with the trip to and from and the time at the Greenbrier Christian Retreat in Crawley, West Virginia. I certify that my child is able to participate in the activities (unless otherwise indicated). If my child has medical conditions which may be relevant to a physician in the event of an emergency, I have listed them on the registration form. There are no medical facilities on site at Greenbrier Christian Retreat. I hereby authorize the adult sponsors to make emergency medical decisions for my child. If there are any activities I do not want my child to be involved in I have listed them on the registration form. I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED ON SAID ACTIVITIES, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT THERETO. I do hereby agree to hold Greenbrier Christian Retreat, volunteers, board members, agents and employees harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child or property, even injury resulting in death, which I now have or which may arise in the future in connection with the activity of participation in any other associated activities. I also grant Greenbrier Christian Retreat and Camp representatives and employees the right to take photographs/videos of my child/children while they are at camp. I authorize Greenbrier Christian Retreat, Camp assignees and transferees to copyright, use and publish the same in print and/or electronically. I agree that Greenbrier Christian Retreat may use such photographs/videos with or without my child/children’s name for any lawful purposes, including for example such purpose as publicity, illustration, advertising and web content. I expressly agree that this release, waiver and indemnity agreement is intended to be broad and inclusive as permitted by law of the State of West Virginia and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full force and effect. This release contains the entire agreement between the parties hereto, and the terms of this release are contractual and not a mere recital. ALL RIGHTS OF VENUE WILL BE HELD IN GREENBRIER COUNTY, WEST VIRGINIA. I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement which I have read and understand. By Signing below I am submitting my child that I am legally in charge, to the rules and guidelines of Greenbrier Christian Retreat. I understand at the time of signing I am not under the influence of any drug or alcohol and am in complete understanding of the agreement that I am signing.
CAMPER / Attendee Agreement:
As a Camper/ Attendee I understand that I will abide by the rules and guidelines of Greenbrier Christian Retreat. I will submit to the authority of the camp Directors, Councilors, and Leaders of Greenbrier Christian Retreat as they work to maintain guidelines in line with Greenbrier Christian Retreat. I understand that Greenbrier leadership can at any time ask me to leave due to improper conduct. At that time parents or guardians will be called to pick me up in the event that I am involved with improper conduct. I also understand as an Camper (Attendee) that I will not bring any alcoholic beverages, Weapons of any nature, Electronic devices, or printed material not in line with the guidelines or rules of Greenbrier Christian Retreat. I also understand at some time during my stay that I may be included in marketing material used to promote camp. I give full permission to use my image for the marketing purposes of the camp. I will refrain from improper language and will at the best of my ability behave in a godly manner.